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Acquired origin of the left anterior descending coronary artery from the pulmonary artery: A complication of the arterial switch operation.

Saltik L, Baris S, Ozyilmaz I, Eroğlu AG - Ann Pediatr Cardiol (2011)

Bottom Line: The prevalence of coronary anomalies in the transposition of the great arteries is high.Transfer of the coronary arteries during arterial switch operation is the principle step and incomplete transport of the coronary arteries to the neoaortic root results into iatrogenic coronary problems.We present a case with the residual left anterior descending coronary artery originating from the pulmonary artery as a complication of the failure of transfer during the arterial switch operation.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Pediatric Cardiology, Cerrahpasa Faculty of Medicine, Istanbul University, Turkey.

ABSTRACT
The prevalence of coronary anomalies in the transposition of the great arteries is high. Transfer of the coronary arteries during arterial switch operation is the principle step and incomplete transport of the coronary arteries to the neoaortic root results into iatrogenic coronary problems. We present a case with the residual left anterior descending coronary artery originating from the pulmonary artery as a complication of the failure of transfer during the arterial switch operation.

No MeSH data available.


Related in: MedlinePlus

Late phase of contrast injection to the right coronary artery demonstrated retrograde filling of the left anterior descending coronary artery (LAD) via intramyocardial collaterals and shunting to pulmonary artery
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Figure 2: Late phase of contrast injection to the right coronary artery demonstrated retrograde filling of the left anterior descending coronary artery (LAD) via intramyocardial collaterals and shunting to pulmonary artery

Mentions: A 16 year old post-operative, asymptomatic boy was undergoing cardiovascular evaluation. The patient had undergone arterial switch operation at 4 months of life for transposition of the great arteries, ventricular septal defect, and pulmonary hypertension and was discharged without any problem. Following the arterial switch operation, he had been followed up with no symptoms until when an echocardiographic examination at 5 years of age revealed mild-to-moderate aortic valve insufficiency and a flow disturbance in the interventricular septum. Cardiac catheterization and angiography demonstrated that the left circumflex artery was arising from the right coronary artery and the left anterior descending coronary artery from the pulmonary artery which accompanied abundant intramyocardial collaterals [Figures 1 and 2]. When we reviewed the details of surgery, we noticed that the single coronary artery was transported to the neoaortic root, whereas the small conal artery was not transported because of technical difficulty (possibly this was the left anterior descending artery). The child was reevaluated at 15 years of age, after an irregular follow-up period, during which he had no symptoms. His electrocardiogram was normal, with no change in the ST-T segment. We performed thallium scintigraphy which revealed no myocardial ischemia. Repeat coronary angiography revealed mild-to-moderate aortic valve insufficiency and stenosis of the pulmonary bifurcation similar to the previous examination. Because of the high risk of sudden death, surgical intervention was planned.


Acquired origin of the left anterior descending coronary artery from the pulmonary artery: A complication of the arterial switch operation.

Saltik L, Baris S, Ozyilmaz I, Eroğlu AG - Ann Pediatr Cardiol (2011)

Late phase of contrast injection to the right coronary artery demonstrated retrograde filling of the left anterior descending coronary artery (LAD) via intramyocardial collaterals and shunting to pulmonary artery
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3104536&req=5

Figure 2: Late phase of contrast injection to the right coronary artery demonstrated retrograde filling of the left anterior descending coronary artery (LAD) via intramyocardial collaterals and shunting to pulmonary artery
Mentions: A 16 year old post-operative, asymptomatic boy was undergoing cardiovascular evaluation. The patient had undergone arterial switch operation at 4 months of life for transposition of the great arteries, ventricular septal defect, and pulmonary hypertension and was discharged without any problem. Following the arterial switch operation, he had been followed up with no symptoms until when an echocardiographic examination at 5 years of age revealed mild-to-moderate aortic valve insufficiency and a flow disturbance in the interventricular septum. Cardiac catheterization and angiography demonstrated that the left circumflex artery was arising from the right coronary artery and the left anterior descending coronary artery from the pulmonary artery which accompanied abundant intramyocardial collaterals [Figures 1 and 2]. When we reviewed the details of surgery, we noticed that the single coronary artery was transported to the neoaortic root, whereas the small conal artery was not transported because of technical difficulty (possibly this was the left anterior descending artery). The child was reevaluated at 15 years of age, after an irregular follow-up period, during which he had no symptoms. His electrocardiogram was normal, with no change in the ST-T segment. We performed thallium scintigraphy which revealed no myocardial ischemia. Repeat coronary angiography revealed mild-to-moderate aortic valve insufficiency and stenosis of the pulmonary bifurcation similar to the previous examination. Because of the high risk of sudden death, surgical intervention was planned.

Bottom Line: The prevalence of coronary anomalies in the transposition of the great arteries is high.Transfer of the coronary arteries during arterial switch operation is the principle step and incomplete transport of the coronary arteries to the neoaortic root results into iatrogenic coronary problems.We present a case with the residual left anterior descending coronary artery originating from the pulmonary artery as a complication of the failure of transfer during the arterial switch operation.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Pediatric Cardiology, Cerrahpasa Faculty of Medicine, Istanbul University, Turkey.

ABSTRACT
The prevalence of coronary anomalies in the transposition of the great arteries is high. Transfer of the coronary arteries during arterial switch operation is the principle step and incomplete transport of the coronary arteries to the neoaortic root results into iatrogenic coronary problems. We present a case with the residual left anterior descending coronary artery originating from the pulmonary artery as a complication of the failure of transfer during the arterial switch operation.

No MeSH data available.


Related in: MedlinePlus